Download Einkünfte von Ärzten 2003

Prof. Dr. Karl Lauterbach MdB
The “Cancer Industry”
and Pharmaceutical Policy in Germany
Dr. Karl Lauterbach, MD, ScD, MPH (HSPH ‘92)
Professor of Health Economics and Clinical Epidemiology,
University of Cologne
Member of the Deutscher Bundestag
Deputy Leader of the Social Democratic Parliamentary Group
Author of the new book The Cancer Industry
Seite 1
Prof. Dr. Karl Lauterbach MdB
Probability of developing cancer in Germany
in Percent
Birth to Death
60
50.8
50
42.9
40
30
20
10
0
Male
Source: Robert Koch-Institut, Krebs in Deutschland, 2009/2010, Berlin 2013
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Female
Prof. Dr. Karl Lauterbach MdB
Probability of dying of cancer in Germany
in Percent
Birth to Death
30
25.8
25
22.2
20
15
10
5
0
Male
Source: Robert Koch-Institut, Krebs in Deutschland, 2009/2010, Berlin 2013
Seite 3
Female
Prof. Dr. Karl Lauterbach MdB
Incidence rates for cancer in Germany, by gender
and age (per 100,000 population)
Female
Male
Source: Robert Koch-Institut, Krebs in Deutschland, 2009/2010, Berlin 2013
Seite 4
Prof. Dr. Karl Lauterbach MdB
Estimated cumulative risk of developing cancer in
Great Britain for 1960 cohort
Source: A S Ahmad, N Ormiston-Smith and P D Sasieni,:Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960.
British Journal of Cancer (2015) 112, 943–947
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Prof. Dr. Karl Lauterbach MdB
Hallmarks of cancer
Limitless replicative potential
Non-cancer cells die after a certain number of divisions. Cancer cells escape this limit and are
apparently capable of indefinite growth and division (immortality).
Insensitivity to anti-growth signals
Self-sufficiency in growth signals
Sustained angiogenesis
Angiogenesis is the process by which new blood vessels are formed. Cancer cells appear to
be able to kickstart this process, ensuring that such cells receive a continual supply of oxygen
and other nutrients
Source: Hanahan D., Weinberg R.A.: "The Hallmarks of Cancer". Cell 100 (1): 57–70. (2000) and
Hanahan, D.; Weinberg, R. A.: "Hallmarks of Cancer: The Next Generation". Cell 144 (5): 646–674 (2011)
https://en.wikipedia.org/wiki/The_Hallmarks_of_Cancer#Limitless_replicative_potential
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Prof. Dr. Karl Lauterbach MdB
Hallmarks of cancer
Evading apoptosis
Apoptosis is a form of programmed cell death (cell suicide), the mechanism by which cells are
programmed to die in the event they become damaged. Cancer cells are characteristically
able to bypass this mechanism.
Tissue invasion and metastasis
Cancer cells can break away from their site or organ of origin to invade surrounding tissue and
spread (metastasize) to distant body parts.
Evading the immune system
Cancer cells appear to be invisible to the body’s immune system.
Deregulated metabolism
Most cancer cells use abnormal metabolic pathways to generate energy, a fact appreciated
since the early twentieth century with the postulation of the Warburg hypothesis, but only now
gaining renewed research interest.
Source: Hanahan D., Weinberg R.A.: "The Hallmarks of Cancer". Cell 100 (1): 57–70. (2000) and
Hanahan, D.; Weinberg, R. A.: "Hallmarks of Cancer: The Next Generation". Cell 144 (5): 646–674 (2011)
https://en.wikipedia.org/wiki/The_Hallmarks_of_Cancer#Limitless_replicative_potential
Seite 7
Prof. Dr. Karl Lauterbach MdB
New cancer drugs
Tyrosine kinase inhibitors
Protein kinases play a crucial role in signal transduction and also in cellular proliferation,
differentiation and various regulatory mechanisms. The inhibition of growth-related kinases,
especially tyrosine kinases, might therefore provide new therapies for cancer.
Source: Traxler P.: Tyrosine kinases as targets in cancer therapy - successes and failures. Expert Opin Ther Targets 2003 Apr;7(2):215-34 and
Sebolt-Leopold J.S., English J.M.: Mechanisms of drug inhibition of signalling molecules. Nature 441, 457-462 (25 May 2006)
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Prof. Dr. Karl Lauterbach MdB
New cancer drugs
Monoclonal antibodies
Antibodies have the unique capacity to target and kill tumor cells while simultaneously
activating immune effectors to kill tumor cells through the complement cascade or antibodydependent cellular cytotoxicity (ADCC). This multifaceted mechanism of action combined with
target specificity underlies the capacity of antibodies to elicit anti-tumor responses while
minimizing the frequency and magnitude of adverse events.
Source: Shuptrine C.W., Surana R., Weiner L.M.: Monoclonal antibodies for the treatment of cancer.
Semin Cancer Biol 2012 Feb;22(1):3-13. doi: 10.1016/j.semcancer.2011.12.009. Epub 2012 Jan 8
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Prof. Dr. Karl Lauterbach MdB
New cancer drugs
Checkpoint inhibitors
The immune system depends on multiple checkpoints or “immunological brakes” to avoid
overactivation of the immune system on healthy cells. Tumor cells often take advantage of
these checkpoints to escape detection by the immune system. CTLA-4 and PD-1 are
checkpoints that have been studied as targets for cancer therapy. Inhibiting a checkpoint (ie,
“releasing the brakes”) on the immune system may enhance the anti-tumor T-cell response.
This class of therapy has shown efficacy in cancer and clinical trials are ongoing.
Source: http://www.fightcancerwithimmunotherapy.com/ImmunotherapyAndCancer/TypesOfCancerImmunotherapy.aspx and
Sharma P., Wagner K., Wolchok J.D., Allison J.P.. Novel cancer immunotherapy agents with survival benefit: recent successes and next steps. Nature
reviews Cancer. 2011;11(11):805-812. doi:10.1038/nrc3153.
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Prof. Dr. Karl Lauterbach MdB
Number of active products in the pipeline to date = 6234
Source: IMS Institute: Global Oncology Trend Report, 2014
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Prof. Dr. Karl Lauterbach MdB
Top 10 pharmaceutical companies based on global
oncology revenue in 2014 and 2020
(in million U.S. dollars)
2020
0
5000
10000
2014
Revenue in million U.S. dollars
15000
14,197
7,407
12,614
Bristol-Myers Squibb
3,833
11,314
Novartis
8,729
8,388
Pfizer
3,046
6,812
Johnson & Johnson
4,158
6,725
Astra Zeneca
Eli Lilly
2,997
5,332
1,459
5,167
2,986
4,964
2,875
Source:EvaluatePharma - World Preview 2015, Outlook to 2020
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30000
25,828
Celgene
Merck & Co
25000
28,467
Roche
Astellas Pharma
20000
Prof. Dr. Karl Lauterbach MdB
“In the United States, the average price of cancer
drugs for about a year of therapy increased from
$5000 to $10,000 before 2000 to more than $100,000
by 2012, while the average household income has
decreased by about 8% in the past decade. Further,
although 85% of cancer basic research is funded
through taxpayers’ money, Americans with cancer
pay 50% to 100% more for the same patented drug
than patients in other countries.”
Hagop Kantarjian, MD, and S. Vincent Rajkumar, MD
Source:Mayo Clin Proc. 2015;90(4):500-504
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Prof. Dr. Karl Lauterbach MdB
Five charges against drug companies
1:
The high prices of cancer drugs don‘t correlate
with their benefits.
2:
The high prices don‘t result from research and
development but serve only the profit interests of
the companies.
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Prof. Dr. Karl Lauterbach MdB
Five charges against drug companies
3:
The companies misuse their market power.
4:
The pharmaceutical companies often obstruct
research.
5:
The high drug prices will burst the healthcare
systems.
Seite 15
Prof. Dr. Karl Lauterbach MdB
Pay for benefit
the AMNOG
in Germany
Seite 16